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URINALYSIS

Urinalysis

Purpose: - aid in diagnosis - screen for asymptomatic, congenital or hereditary disease - monitor disease progression - monitor therapy effectiveness/complications
ideal specimen: - midstream clean catch specimen - first morning specimen

Physical Examination:
Color: yellow - normal urine urochrome, urobilin, uroerythrin

darkening of yellow urine -

fever starvation thyrotoxicosis

red/red brown - blood myoglobin

Physical Examination:
Color: yellow brown/amber - bilirubin

Black
Green/blue

- melanin
- Chlorophyll Pseudomonas

Physical Examination:
Clarity: - transparency of specimen - terms: Clear hazy Cloudy Turbid Odor:

- faint aromatic odor - normal - ammoniacal odor - long standing UTI

Physical Examination:
Urine Volume: - done during timed collection - average daily volume: 600-2000 mL - average night volume: <400 mL Polyuria - > 4 liters/day - Compulsive water intake - diabetes mellitus - diabetes insipidus - renal disease - drugs

Physical Examination: A Urine Volume:

Nocturia - > 500 ml sp. Grav. <1.018 Oliguria - <400 mL/day; sp. grav. 1.030 - dec. renal blood flow dehydration shock, hypotension - Renal disease Urinary tract obstruction end stage renal disease

Physical Examination: Urine Volume:

Anuria - no urine excreted - acute Renal failure ischemia nephrotoxicity - Urinary tract obstruction - Hemolytic transfusion reaction

Physical Examination: Specific Gravity

- ratio of density of urine to the density of an equal volume of water - normal: 1.005-1.035 - Urea, NaCl, sulfate, phosphate - included in chemical examination with reagent strip method

Physical Examination: Specific Gravity

Urinometer - direct determination of Specific gravity - glass float - disadvantages: large volume of urine required daily calibration temperature correction done for difference of 3C from calibrated temp

Chemical Examination: Reagent strip method:

rapid screening of large number of specimen easy to use complex, multiple chemical reactions examines: pH bilirubin proteins urobilinogen glucose nitrite ketone leukocyte esterase blood sp. gravity ascorbic acid

Chemical Examination: pH:

- double indicator system methyl red bromthymol blue - reflection of the renal ability to maintain normal hydrogen ion concentration
- normal pH - 4.6 - 8

Chemical Examination: Protein: - protein errors of pH indicators - normal: 150 mg CHON/day - Proteinuria pre-renal - overflow proteinuria hemoglobin myoglobin acute phase reactants Renal - Glomerular Tubular Post-renal - inflammation, malignancy injury

Chemical Examination: Protein: Bence Jones protein - multiple myeloma macroglobulinemia - coagulated proteins at 40-60C and redissolve at 100C Heavy Proteinuria - (>3 to 4 grams/day) nephrotic syndrome congestive heart failure connective tissue disease

Chemical Examination: Protein:

Moderate Proteinuria - (1-3 or 4 g/day) renal disease multiple myeloma toxic nephropathies Minimal Proteinuria - (<1.0 g/day) chronic pyelonephritis congenital diseases

Chemical Examination:

Glucose: - double-sequential enzyme reaction


- Glucose threshold level: - Diabetes Mellitus Endocrine disorders 160-180mg/dl

Microscopic Examination:
Formed elements in Urine: Blood cells Red blood Cells White blood Cells Epithelial Cells Squamous Epithelial cells Transitional Epithelial cells Renal tubular epithelial cells

Microscopic Examination:
Casts

Matrix
Inclusion

Pigments Cells

Hyaline Waxy granular fat globules hemosiderin granules crystal melanin granules hemoglobin, myoglobin, bilirubin Erythrocytes Leukocytes Renal tubular epithelial cells Mixed cells

Microscopic Examination:
Crystals found in Normal acidic Urine Amorphous Urates

Uric Acid
Calcium oxalates

Microscopic Examination:
Crystals found in Normal alkaline Urine Amorphous phosphates

Crystalline phosphates
Calcium carbonates Ammonium biurate

Microscopic Examination:
Crystals found in abnormal Urine Cystine tyrosine Leucine

Sulfonamides/Sulfadiazine Ampicillin
Cholesterol

Microscopic Examination:
Other formed elements: Mucus Threads

Bacteria
Yeast Trichomonas vaginalis